NIHR Signal Common osteoporosis drugs may prevent breast cancer spreading to bone

NIHR Signal Common osteoporosis drugs may prevent breast cancer spreading to bone
          
Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However, the overall benefits may be small, for example preventing spread to bone or death in about one extra woman in every 100 treated for about five years. This is a complex area because many of the treatments for breast cancer are known to worsen bone thinning, but there are other bone strengthening benefits to these drugs.
Published on 13 March 2018
Read full document at https://discover.dc.nihr.ac.uk/portal/article/4000967/common-osteoporosis-drugs-may-prevent-breast-cancer-spreading-to-bone

Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis

This guideline, from the American College of Rheumatology, provides direction for clinicians and patients making treatment decisions on the the prevention and treatment of glucocorticoid-induced osteoporosis.

Bisphosphonates for treating osteoporosis [TA464]

Oral bisphosphonates (alendronic acid, ibandronic acid and risedronate sodium) are recommended as options for treating osteoporosis in adults only if:

• The person is eligible for risk assessment as defined in NICE's guideline on osteoporosis (recommendations 1.1 and 1.2) andthe 10‑year probability of osteoporotic fragility fracture is at least 1%.
• Intravenous bisphosphonates (ibandronic acid and zoledronic acid) are recommended as options for treating osteoporosis in adults only if:the person is eligible for risk assessment as defined in NICE's guideline on osteoporosis (recommendations 1.1 and 1.2) and the 10‑year probability of osteoporotic fragility fracture is at least 10% or the 10‑year probability of osteoporotic fragility fracture is at least 1% and the person has difficulty taking oral bisphosphonates (alendronic acid, ibandronic acid or risedronate sodium) or these drugs are contraindicated or not tolerated.
• Estimate the 10‑year probability of osteoporotic fragility fracture using the FRAX or QFracture risk tools, in line with NICE's guideline on osteoporosis.
• The choice of treatment should be made on an individual basis after discussion between the responsible clinician and the patient, or their carers, about the advantages and disadvantages of the treatments available. If generic products are available, start treatment with the least expensive formulation, taking into account administration costs, the dose needed and the cost per dose.
• These recommendations are not intended to affect treatment with alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid that was started in the NHS before this guidance was published. Adults having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Risk assessment is key to osteoporosis care, says NICE

Updated guidance sets out priorities for better management of osteoporosis in adults, including assessing risks and preventing bone fragility fractures.

The National Institute for Health and Care Excellence (NICE) quality standard, published in April, says healthcare professionals should consider all options to prevent and treat fractures as part of their care for people with osteoporosis.

Long term conditions scenarios: osteoporosis and wound care

NHS RightCare has published two new scenarios in its long term conditions series. The scenarios, on osteoporosis and wound care, use fictional people to examine patient journeys, comparing sub-optimal but typical scenarios against ideal pathways. The scenarios contain modelled costs of care for commissioners.

Guideline 142:Management of osteoporosis and the prevention of fragility fractures

Quick reference guide from SIGN for their guideline on the management of osteoporosis and the prevention of fragility fractures.

People at risk of fractures due to osteoporosis should be considered for medication

In its draft quality standard on osteoporosis NICE says those at medium or high risk and diagnosed with osteoporosis should be offered medicines to help strengthen their bones and prevent fractures.